title: Renal transplantation across ABO barrier.
abstract: In India, patients without a compatible blood group donor are usually excluded from renal transplantation. For young patients, it is a difficult therapeutic choice to stay on long-term dialysis. We describe the case of a 19-year-old male patient who had blood group O +ve and had no compatible donor in the family. His mother was B +ve and was willing to donate. The patient had an initial anti-B antibody titer of 1:512 and underwent antibody depletion with plasmapheresis (11 sessions) and intravenous immunoglobulin (IVIG) 100 mg/kg after every plasmapheresis. He also received rituximab 500 mg for 3 days prior to transplant and was induced with basiliximab. At the time of transplant, his anti-B titers were <1:8. Post-operatively, he required four sessions of plasmapheresis and IVIG as his titers rebounded to 1:64. The titers then spontaneously subsided to <1:16 and have stayed at the same level for 6 months post-transplant. The patient continues to have normal renal function with a creatinine of 1.4 mg/dl% and has had no episodes of rejection.
authors.affiliation: Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta the Medicity, Gurgaon, Haryana, India.
authors.forename: P N
authors.initials: PN
authors.lastname: Gupta
authors.forename: S
authors.initials: S
authors.lastname: Pokhariyal
authors.forename: S
authors.initials: S
authors.lastname: Bansal
authors.forename: S
authors.initials: S
authors.lastname: Jain
authors.forename: V
authors.initials: V
authors.lastname: Saxena
authors.forename: R
authors.initials: R
authors.lastname: Sharma
authors.forename: M
authors.initials: M
authors.lastname: Jain
authors.forename: P
authors.initials: P
authors.lastname: Jha
authors.forename: S K
authors.initials: SK
authors.lastname: Sethi
authors.forename: P
authors.initials: P
authors.lastname: Ghosh
authors.forename: A
authors.initials: A
authors.lastname: Tewari
authors.forename: R
authors.initials: R
authors.lastname: Ahlawat
authors.forename: V
authors.initials: V
authors.lastname: Kher
keywords: ABO incompatible; chronic kidney disease; renal transplant